CC BY
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BecTHUK Ka3H MY, №3(3)- 2014
E. Slobodenyuk
SCIENTIFIC JUSTIFICATION OF WORK OF RESUSCITATION UNIT OF CITY HOSPITAL IN MODERN CONDITIONS
Resume: In article questions of an assessment of quality of medical care in the conditions of reanimation office are discussed. The increase in number of the patients needing rendering emergency medical care, the increased role of resuscitation service defines need of the regular analysis of activity of office of reanimation. Studying of influence of social and economic factors on professional activity of resuscitators, an assessment of quality of the resuscitation help in hospital conditions - a basis for development action for optimization of the resuscitation help.
Keywords: public health services, medical aid, quality of medical care, reanimation office.
YflK: 618.8:577.16-616-08
D.R. Zhangaliyeva
VITAMINS IN THE COMPLEX THERAPY OF PERIPHERAL NERVOUS SYSTEM DISEASES
Treatment of combination therapy in the treatment of diseases of the peripheral nervous system, not only has not lost its value, but got deeper reason. Modern correction mielinopaty as systemic metabolic disorders, is impossible without timely and adequate treatment of products containing vitamins and magnesium. Keywords: vitamins, magnesium, peripheral nervous system
System damage to peripheral nerves (polyneuropathy), and damage to individual nerve trunks (neuropathy) constitute a large group of diseases of the peripheral nervous system of various etiology and pathogenesis of complex, leading to the destruction of nerve fibers or their shells. The prevalence of pathological processes that occur with peripheral nerve damage is so great that most of the complaints of patients to the neurologist is associated with them. International Statistical Classification of Diseases (ICD-10) contains an extensive section (G 50-64), which includes all the variety of clinical variants neuropathies: from the destruction of individual nerve root and plexus to systemic polyneuropathy.
Damage to the peripheral nerves may be caused by metabolic disorders, ischemia, blood diseases, intoxication, nutritional factors, injuries, allergic reactions, inflammation and other causes.
Pathology formations of peripheral nervous system acts as an independent disease or clinical syndrome and as often occurs in practice, doctor, that no one person as a therapeutic and surgical can not ignore this problem. Go to the peripheral nervous system includes front and rear roots of the spinal cord, intervertebral spinal ganglia, spinal nerves and their plexus, peripheral nerves, as well as roots and ganglia of the cranial nerves and cranial nerves. Formation of peripheral nerve is as follows. Following the periphery of the spinal cord (or cranial) spinal nerve (or cranial nerves) consisting of portions of motor, sensory fibers to form a peripheral nerve. Peripheral nerves are mostly composites of motor fibers anterior roots (anterior horn cell axons), sensory fibers (dendrites cells intervertebral nodes), and vasomotor-secretory-trophic fibers (sympathetic and parasympathetic) from the corresponding cells of the gray matter of the spinal cord lateral horn and the ganglia of the sympathetic trunk border. Nerve fiber, part of the peripheral nerve consists of an axial cylinder located in the center of the fiber, the myelin sheath, the dressing axial cylinder and Schwann sheath. Major nerve trunks consist of 800 thousand. - 1 million nerve fibers that provide a significant margin of safety function of the
peripheral nervous system. It is believed that the function of the nerve trunk is broken only in the case of the death of half of the nerve fibers.
The myelin sheath of the nerve fiber is interrupted in some places, forming the so-called nodes of Ranvier. For many years it was believed that the role of the myelin sheath provides an electrical insulator in the process of excitation along the nerve fiber. However, the role of the myelin sheath is probably more significant - it is directly involved in the formation of the electric potential of the nerve fiber. Sure, its involvement in the metabolism of the nerve cell is extremely high - the function of the nerve fiber is broken in case of damage of the myelin sheath. Connective tissue in the peripheral nerves represented shells, dress up the nerve trunk (epineurium), its individual beams (perineurium) and nerve fibers (endoneurium). In the shells are vessels that feed the nerves. The myelin sheath is the bulk of the peripheral nerve.
Myelin - a substance consisting of cholesterol, phospholipids and proteins - the result of folate-dependent synthesis of flowing with the direct participation of the enzyme methylenetetrahydrofolate reductase (MTHFR) and coenzymes (folic acid and vitamin B).
The myelin sheath - the most vulnerable part of the peripheral nerve. She suffers as a result of the destruction of (toxic, immune mechanisms) or insufficient synthesis of myelin components (metabolic disorders, vitamin deficiencies). In any case, the synthesis of myelin requires substantial voltage multiple enzyme systems since the total weight of this substance in the body than 200 g. The clinical syndrome of peripheral nerve injury is most often associated with segmental demyelination of nerve fibers. Segmental demyelination (mielinopatiya) indicates damage to the myelin sheath with preservation of axons. The most significant functional manifestation of demyelination is the blockade of conductivity. The functional deficiency in the locked axon manifested as well as in the axon crossing. Despite the fact that the intersection of the nerve conduction block and in demyelination exhibit affinity severity of motor and sensory disorders, there are
Вестник КазН МУ, №3(3)- 2014
differences between them. So, in demyelinating neuropathies blockade of conductivity is often transient and remyelination can occur quickly, within days or weeks, often resulting in recovery [1].
Thus, when the process is more favorable prognosis, and the recovery is faster than within. The most important clinical sign of segmental demyelination is a disorder of the functions of the distal peripheral type: the greater the length of the peripheral nerve, the more noticeable are conduction abnormalities. First of all, it shows sensitivity disorders in the distal extremities.
Vitamin B6 - pyridoxine is a coenzyme of more than 100 enzymes involved in the synthesis of neurotransmitters (tryptophan, glycine, serotonin, dopamine, norepinephrine, epinephrine, histamine). It lowers cholesterol, homocysteine. Vitamin B6 controls erythropoiesis and is involved in the immune response. There is a convincing correlation between the reduction of pyridoxine in the blood and the clinical manifestations of polyneuropathy. Magnesium - is one of the most important nutrients, which is a cofactor for many enzymatic reactions. Plays an important role in the nervous system, is involved in the regulation of transmission of nerve impulses and muscle contraction in most metabolic reactions, contributes to energy production and consumption, plays an important physiological role in the maintenance of ion balance. Magnesium is involved in the synthesis of all currently known neuropeptides of the brain and is responsible for the transmission of braking signals from the center (of the head) to the peripheral nerves and muscles. Magnesium is an antistress macronutrients has a normalizing effect on the nervous system and its higher departments (especially in combination with vitamin B6 - pyridoxine) with nervous tension, depression, neurosis. It nourishes the nerve cells, prevents depression and reduces the effects of stress, reduces fatigue, irritability, normalizes sleep. B vitamins and magnesium are central to the treatment of diseases of the peripheral nervous system. Among the many diseases of the nervous system are the most important indications for vitamins and magnesium with polyneuropathy of various origins [2]. Although the etiology of polyneuropathy is extremely diverse, lack of B vitamins, magnesium unites the majority of clinical variants of this neurological syndrome. According to the literature polyneuropathy arising from complications of diabetes or alcohol intoxication, over two thirds of all cases of
polyneuropathy. In addition to reducing the manifestations of disorders of sensitivity, vitamins and magnesium with polyneuropathy have a significant impact on the manifestation of vegetative-trophic disorders in the form of neuropathic diabetic foot syndrome.
Systemic metabolic disorders that occur with obesity in recent years, increasing attention of doctors. Surgical treatment of morbid obesity is becoming a more common practice. Surgical reconstruction of the gastrointestinal tract often makes patients from a number of fatal complications. Subsequently, however, as a result of violations of the process of assimilation of biologically important substances, patients often suffer from violations of the peripheral nervous system. Patients after surgical operations for morbid obesity require compensatory treatment with the obligatory inclusion of B vitamins and magnesium during the rehabilitation period. The main purpose of appointing vitamins, magnesium in this case is to prevent dismetabolic polyneuropathy.
Acute inflammatory demyelinating polyneuropathy require parenteral administration of B vitamins in acute and recovery period. At the same time to activate the synthesis of myelin requires a combination of B vitamins and folic acid. Relatively short course of vitamin therapy require radiculopathy associated with vertebrogenic factors. When the cause of compression spine B vitamins prescribed for 2-3 weeks, which greatly speeds up the process of rehabilitation. Thus, treatment of combination therapy in the treatment of diseases of the peripheral nervous system, not only has not lost its value, but got deeper reason. Should be considered an absolute indication appointment combined preparation in all cases of damage to the nervous system, which are based on the processes of demyelination and remyelination violations.
Modern correction mielinopaty as systemic metabolic disorders, is impossible without timely and adequate treatment with drugs containing pyridoxine and magnesium. In diseases occurring with disorders of carbohydrate, fat and protein metabolism (diabetes) systemic treatment combination therapy is necessary for activation of metabolic processes, the recovery processes of synthesis of protein compounds. Preparations containing vitamins and magnesium are essential for patients suffering from malabsorption of essential coenzymes (alcoholism, patients undergoing complex reconstructive surgery on the organs of the gastrointestinal tract).
References
1 Mooney S., Leudorf J.E. Vitamin B6: a long known compound of surprising complexity. - Molecules. - 2009. - T.14. - Р. 329 - 51.
2 Зиновьева О.Е. Препараты альфа-липоевой кислоты в лечении диабетической полиневропатии. //Неврология, психиатрия, нейросоматика. - 2009. - № 1. - С. 58 - 62.
Д.Р. Жангалиева
ШЕТК1 ЖYЙКЕ ЖYЙЕGНIH1 АУРУЛАРЫН КЕШЕНД1 ЕМДЕУДЕГ1 ВИТАМИНДЕР
Ty^^ Шетк жYЙке жYЙесi ауруларынын, кешендi емЫде бiрiктiрiлген препараттармен емдеу ез мэын жоfалтпай, бурын^дан да тере^рек негздеуге ие болды. ЖYЙеслi алмасу бузылыстары ретЫде миелопатиянынын заманауи коррекциясы курамында витаминдер мен магнж бар препараттармен заманауи жэне адекватты емдеуаз мYмкiн емес. ТYЙiндi сездер: витаминдер, магний, шетк жYЙке жYЙесi
Вестник КазН МУ, №3(3)- 2014
Д.Р. Жангалиева
ВИТАМИНЫ В КОМПЛЕКСНОЙ ТЕРАПИИ ЗАБОЛЕВАНИЙ ПЕРИФЕРИЧЕСКОЙ НЕРВНОЙ СИСТЕМЫ
Резюме: Лечение комбинированными препаратами в комплексной терапии заболеваний периферической нервной системы не только не утратило своего значения, но получило более глубокое обоснование. Современная коррекция миелинопатий, как системных обменных нарушений, невозможна без своевременного и адекватного лечения препаратами, содержащими витамины и магний. Ключевые слова: витамины, магний, периферическая нервная система
УДК: 616.1:616.8-009.836-08
Д.Р. Жангалиева
ЖУРЕК-ТАМЫР АУРУЛАРЫ БАР НАУКДСТАРДЬ^Ы ¥ИЦЫ Б¥ЗЫЛЫСТАРЫН ЕМДЕУ ;¥РЫЛЫМЫ МЕН
ЕРЕКШЕЛ1КТЕР1
Мак,алада тYрлi аурулар кез'шдег'! уйкынын бузылулары, олардын тYPлерi мен ерекшел'ктер'!, емдеудег'1 к,иындык,ар
айтылып, оны дурыс емдеу бойынша усыныстар берiледi.
ТYйiндi свздер: уйк,ы бузылуы, инсомния, себептер'1, ерекшел'ктер'!, ем'1
Кез-келген уйкы бузылыстары адам денсауль^ына терк эсерш керсетедГ ейткен уйкы организмнщ циркодиандык биологиялык ы^актарынын, ман,ызды реттепшл болып табылады. Олардын мэн органдар мен жYЙелердiн кызметтерiн, онын сырткы ортамен аезара катынасын реттеушде [1].
Жалпы кабылданfан "уйкысыздык" (инсомния) термин муйкыfа кажеттi уакыт пен шарттардын жеткiлктiгiне карамастан болатын жэне кYндiзгi iс-эрекеттердiн тYрлi бузылыстарымен керЫс беретiн, уйкы инициациясынын,, узактыfынын, консолидациясыны немесе сапасынын кайталанатын бузылыстары" ретшде аныкталады. Алайда, медицинада онын туснт кенiрек - муйкыfа кетудiн бузылуымен, Yздiк-Yздiк беткей кйкымен жэне/немесе мерзiмiнен бурын оянумен керiнестiн уйкы бузылысым.
DSM-IV-те иносомния кYндiзгi калыпты iс-эрекет Yшiн кажеттi тYнгi уйкынын сапасы мен санынын тапшылыfы ретiнде аныкталады. МКБ-10-да иносомния, гиперсомния жэне уйкы ы^а^нын, бузылыстары бiрге "эмоциямен байланысты болатын уйкы сапасынын,, узыкты^ынын немесе ы^а^нын, бузыуы болатын бiрiншiлiк психогендi жаедай" дегендi бiлдiредi. Этиопатогендiк фактор бойынша иносомниянын, келесi санаттарын ажыратады:
• психологиялык проблемалар туfызfан уйкысыздык;
• медициналык проблемалар туfызfан уйкысыздык;
• емiр салтына байланысты уйкысыздык;
• уйкынын бурыс гигиенасынан туындаfан уйкысыздык;
• тукым куалайтын уйкысыздык.
¥йкы бузылысынын, диагностикасы теменде керсетiлген белгтердщ туракты тYPДе (бiр айдан аса) немесе кезен,-кезен^мен (Yш айдан аса) Yшеуiнiн, жэне одан да кебЫщ болуын аныктаудан турады:
• уйкыfа кету Yшiн 30 минуттан аса уакыт керек,
• тYнiмен баска "ойлар келедi",
• уйкыfа кетудщ мYмкiн еместiгiнен корку,
• тYнде жж ояну,
• ерте ояну жэне кайта уйкыfа кетудщ мYмкiн болмауы,
• кен,т ^йдщ темендеуi жэне депрессия,
• себепаз мазасыздыздык, корку.
2005 жылы уйкы бкзылыстарынын, жан,а халыкаралык жiктелуi бекiтiлдi:
- инсомниялар;
- уйкы кезЫдеп тыныс бузылыстары;
- орталык сипаттаfы гиперсомниялар;
- циркадиандык уйкы ы^а^нын, бузылыстары;
- парасомниялар;
- уйкы кезЫдеп козгалыс бузылыстары. Соматикалык стационар кемепне жYгiнген наукастардын, шамамен 14%-ы медикамент™ коррекцияны кажет ететiн айкын уйкы бузылуынан зардап шегедi.
¥йкы бузылуларымен кез-келген аурулар кезiндегi кептеген ша^мдар байланысты. Бул бузылыстар таралуы (50% дейш), тiршiлiкке эсерi, экономикалык жэне уакыт шы^ындары бойынша алдын^ы орында [2]. Дэр^ерлердщ пiкiрiнше, кеп жаедайларда инсомния негiзгi ауруfа катысты алfанда, психиалык болсын не соматикалык болсын, еюншЫк болып табылады. Сондыктан уйкы проблемаларынын, 80%-на дейiн бейорганикалык этиологиялы, сонын, катарында психогендi алfышарттары бар деп есептеледГ Пайда болуы мен ал^шарттарынынын, болуы себептi бiрiншiлiк жэне екшшЫк уйкы бузылуларын ажыратады. Бiрiншiлiкке тYнгi миоклонусты, аяктардын, тYнде мазасыздануын жэне тYнгi апноэнi (уйкыда тыныстын, бузылуы жэне сон,ынан оянып кету) жаткызылады. Екiншiлiк уйкы бузылулары инсомния симптомы болып табылатын сомалык аурулармен, неврологиялык закымданулармен, психикалык бузылыстармен байланысты болады.
А^мынын, узактыfы бойынша эпизодтык,, кыска мерзiмдi жэне созылмалы инсомнияларды ажырытыды. Эпизодтык инсонмия (узактыfы бiр аптаfа дейiн) - кебiне эмоциялык ^йзелктщ, тетенше жаедайлардын,, десинхроноздын,, тулfанын, сомалык ауруларfа реакциясынын, салдары. Кейде уйкынын эпизодтык бузылуы сырткы тiтiркендiргiштерге (мысалы, шу, жарык, белме температурасынын, жоfарылауы не темендеуi) сезiмталдык болfанда сол тiтiркендiргiштен туындайды.
